The Pharmaceutical Journal
Vol 280 No 7485 p57-58
19 January 2008

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Prozac — is it worthy of the hype?

In the fourth article in a series on landmark drugs, John Donoghue takes a look at Prozac and the massive media attention it has received over the years. Has Prozac delivered what it promised?

Landmark drugs series

SUMMARY

Hindsight is a great thing; it always comes with 20:20 vision. A cliché perhaps, but often paraded as true, nonetheless. However, an event occurred 20 years ago, the outcomes of which, even with the benefit of hindsight, many find difficult to credit.

The year 1988 saw a number of momentous world events. The Soviet Union withdrew its forces from Afghanistan, Pan Am flight 103 crashed on Lockerbie, Benazir Bhutto became the first woman leader of an Islamic country, the Turin shroud was declared a fake, Roy Orbison died, the human genome project was started and Harry Enfield told us all about “Loadsamoney”.

It was the first time we wore red noses to raise money for charity, Dustin Hoffman won an Oscar for his role in “Rain Man” and CDs outsold vinyl for the first time. NASA scientist James Hansen warned the US congress about the dangers of global warming and the greenhouse effect, George Bush senior told the American electorate to “read my lips” and, so quietly it went completely unnoticed by most people, a future icon was introduced to an unsuspecting world: Prozac.

Prozac (fluoxetine) was a member of a new class of antidepressants, the selective serotonin reuptake inhibitors, or SSRIs as they quickly became known. Its development came from a combination of serendipity and self-interest but for a long time its future was in doubt. Its discoverers, researchers working for Eli Lilly, were unconvinced that it would have any value as an antidepressant, and it languished for 16 years from its discovery in 1972 to its launch in 1988.

It was not the first of the SSRIs, nor has it been the last, but, without any doubt, it has been the most successful, achieving an iconic status shared with few other medicines. How did this success happen? Was it a result of aggressive and perhaps cynical marketing? Was it because of a sea-change in societal attitudes that became more accepting of the medicalisation of emotional distress? Or did this new class of medicines really offer important clinical advantages to people with depression?

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